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PubMed2001

Similarities and differences in distortion-product otoacoustic emissions among four FDA-approved devices.

Similarities and differences in distortion-product otoacoustic emissions (DPOAEs) among four Food and Drug Administration (FDA) approved devices were assessed quantitatively. DPOAEs were recorded from 42 adult subjects (84 ears) ranging in age from 19 to 40 years. All subjects had hearing thresholds of 20 dB HL or better for the test frequencies from 0.25 to 8.0 kHz and normal acoustic immittance findings. DPOAEs were collected in a quiet non-sound-treated room. DPOAE measurement parameters included an f2/f1 ratio of approximately 1.2, with f1 at 65 dB SPL (L1) and f2 at 55 dB SPL (L2). There were no significant differences in the mean emissions levels among the four devices. This investigation showed that validity criteria, pass criteria, and strategies for DPOAE measurements interact to produce varying pass and refer results. However, when DPOAEs are obtained with consistent validity criteria, pass criteria, and strategies for measurement, the results are remarkably consistent.

Adult↗

PubMed2003

Speech perception, localization, and lateralization with bilateral cochlear implants.

Five bilateral cochlear implant users were tested for their localization abilities and speech understanding in noise, for both monaural and binaural listening conditions. They also participated in lateralization tasks to assess the impact of variations in interaural time delays (ITDs) and interaural level differences (ILDs) for electrical pulse trains under direct computer control. The localization task used pink noise bursts presented from an eight-loudspeaker array spanning an arc of approximately 108 degrees in front of the listeners at ear level (0-degree elevation). Subjects showed large benefits from bilateral device use compared to either side alone. Typical root-mean-square (rms) averaged errors across all eight loudspeakers in the array were about 10 degrees for bilateral device use and ranged from 20 degrees to 60 degrees using either ear alone. Speech reception thresholds (SRTs) were measured for sentences presented from directly in front of the listeners (0 degrees) in spectrally matching speech-weighted noise at either 0 degrees, +90 degrees or -90 degrees for four subjects out of five tested who could perform the task. For noise to either side, bilateral device use showed a substantial benefit over unilateral device use when noise was ipsilateral to the unilateral device. This was primarily because of monaural head-shadow effects, which resulted in robust SRT improvements (P<0.001) of about 4 to 5 dB when ipsilateral and contralateral noise positions were compared. The additional benefit of using both ears compared to the shadowed ear (i.e., binaural unmasking) was only 1 or 2 dB and less robust (P = 0.04). Results from the lateralization studies showed consistently good sensitivity to ILDs; better than the smallest level adjustment available in the implants (0.17 dB) for some subjects. Sensitivity to ITDs was moderate on the other hand, typically of the order of 100 micros. ITD sensitivity deteriorated rapidly when stimulation rates for unmodulated pulse-trains increased above a few hundred Hz but at 800 pps showed sensitivity comparable to 50-pps pulse-trains when a 50-Hz modulation was applied. In our opinion, these results clearly demonstrate important benefits are available from bilateral implantation, both for localizing sounds (in quiet) and for listening in noise when signal and noise sources are spatially separated. The data do indicate, however, that effects of interaural timing cues are weaker than those from interaural level cues and according to our psychophysical findings rely on the availability of low-rate information below a few hundred Hz.

Adult↗

PubMed1998

Binaural application of the bone-anchored hearing aid.

Most, but not all, hearing-impaired patients with air conduction hearing aids prefer binaural amplification instead of monaural amplification. The binaural application of the bone conduction hearing aid is more disputable, because the attenuation (in decibels) of sound waves across the skull is so small ( 10 dB) that even one bone conduction hearing aid will stimulate both cochleas approximately to the same extent. Binaural fitting of the bone-anchored hearing aid was studied in three experienced bone-anchored hearing aid users. The experiments showed that sound localization, and speech recognition in quiet and also under certain noisy conditions improved significantly with binaural listening compared to the monaural listening condition. On the average, the percentage of correct identifications (within 45 degrees ) in the sound localization experiment improved by 53% with binaural listening; the speech reception threshold in quiet improved by 4.4 dB. The binaural advantage in the speech-in-noise test was comparable to that of a control group of subjects with normal hearing listening monaurally versus binaurally. The improvements in the scores were ascribed to diotic summation (improved speech recognition in quiet) and the ability to separate sounds in the binaural listening condition (improved sound localization and improved speech recognition in noise whenever the speech and noise signals came from different directions). All three patients preferred the binaural bone-anchored hearing aids and used them all day.

Adult↗

PubMed1980

Aging, dichotic memory and digit span.

Comparisons were made between groups of old and young subjects in a dichotic task. In the first experiment old and young subjects had digit spans representative of their respective populations, and in accord with previous dichotic research younger subjects recalled with greater accuracy. The main effect of group and the Group x Test (ear reported first vs ear reported second) interaction were reliable with both serial and free recall scoring. In the second experiment young subjects were matched to old subjects on the basis of digit span. Matching eliminated the group and Group x Test interaction with seriall recall and the group effect with free recall, suggesting that digit span and dichotic memory are mediated by common mechanisms. Error trends and the Group x Test interactions with free recall revealed that some age related differences persisted even after matching. These differences are discussed in terms of regression artifact and processing capacity.

Adolescent↗

PubMed2003

Second oral language capabilities in children with cochlear implants.

OBJECTIVE: The development of oral language in children with a cochlear implant is dependent on numerous factors. Although baseline achievements have been established, ceiling attainment levels have yet to be explored. One indicator of a higher capability level is the ability of children with implants to learn to communicate orally using a second language. The purpose of this research was to explore 1) the feasibility of children with cochlear implants developing oral fluency in a second language and 2) the factors that affect the development. STUDY DESIGN: Retrospective study of children fulfilling the criteria. SETTING: University medical center. PATIENTS: Eighteen profoundly hearing-impaired children who were reported to be bilingual. INTERVENTION: Cochlear implantation at age 5 or younger. MAIN OUTCOME MEASURES: The subjects were evaluated using standard speech perception and receptive and expressive language measures. RESULTS: The data revealed the ability of some pediatric cochlear implant recipients to develop competency in a second spoken language in addition to their primary language. Equally as important is the fact that the majority showed age-appropriate receptive and/or expressive language abilities in their primary language commensurate with normal-hearing children. CONCLUSION: High levels of achievement including the learning of a second spoken language are possible after implantation in the pediatric population. Variables include speech perception postimplantation, the linguistic environment, type of intervention, and educational placement.

Child↗

PubMed2005

Auditory frequency discrimination in children with specific language impairment: a longitudinal study.

It has been proposed that specific language impairment (SLI) is caused by an impairment of auditory processing, but it is unclear whether this problem affects temporal processing, frequency discrimination (FD), or both. Furthermore, there are few longitudinal studies in this area, making it hard to establish whether any deficit represents a developmental lag or a more permanent deficit. To address these issues, the authors retested a group of 10 children with SLI and 12 control children first tested 42 months previously. At Time 1, the children with SLI (between 9 and 12 years of age) had significantly elevated FD thresholds compared to the matched controls. At Time 2, the thresholds of both groups had improved, but the children with SLI still had poorer FD thresholds than those of the controls. To assess temporal resolution, auditory backward masking was measured and it was found that most of the children with SLI performed as well as the controls, but 2 children had exceptionally high thresholds. There was also greater variability among the children with SLI compared to that measured among the controls on the FD task. These studies indicate considerable heterogeneity in auditory function among children with SLI and suggest that, as with auditory temporal deficits, difficulties in FD discrimination are important in this population.

Adolescent↗

PubMed2004

The benefit of binaural hearing in a cocktail party: effect of location and type of interferer.

The "cocktail party problem" was studied using virtual stimuli whose spatial locations were generated using anechoic head-related impulse responses from the AUDIS database [Blauert et al., J. Acoust. Soc. Am. 103, 3082 (1998)]. Speech reception thresholds (SRTs) were measured for Harvard IEEE sentences presented from the front in the presence of one, two, or three interfering sources. Four types of interferer were used: (1) other sentences spoken by the same talker, (2) time-reversed sentences of the same talker, (3) speech-spectrum shaped noise, and (4) speech-spectrum shaped noise, modulated by the temporal envelope of the sentences. Each interferer was matched to the spectrum of the target talker. Interferers were placed in several spatial configurations, either coincident with or separated from the target. Binaural advantage was derived by subtracting SRTs from listening with the "better monaural ear" from those for binaural listening. For a single interferer, there was a binaural advantage of 2-4 dB for all interferer types. For two or three interferers, the advantage was 2-4 dB for noise and speech-modulated noise, and 6-7 dB for speech and time-reversed speech. These data suggest that the benefit of binaural hearing for speech intelligibility is especially pronounced when there are multiple voiced interferers at different locations from the target, regardless of spatial configuration; measurements with fewer or with other types of interferers can underestimate this benefit.

Adolescent↗

PubMed2005

Pre- and intraoperative predictive factors of facial palsy in vestibular schwannoma surgery.

CONCLUSION: S These results support previous ones with regard to FN risk factors in VS surgery. However, they also provide new preoperative factors that influence postoperative FN function, such as clinical symptoms, the nature of the surgical procedure (use of laser) and ABR results. OBJECTIVE: To determine pre- and perioperative factors influencing facial nerve (FN) outcome in vestibular schwannoma (VS) surgery. MATERIAL AND METHODS: A total of 424 patients undergoing VS surgery were included in this retrospective study. Patients were divided into two groups according to the existence or absence of a FN palsy during the 8 days following surgery (Groups 1 and 2, respectively). Various parameters were evaluated preoperatively as follows. Quantitative parameters: age; duration of clinical symptoms; pure-tone audiometry (PTA) results; speech reception threshold; speech discrimination score; auditory brainstem response (ABR) results; and transient-evoked otoacoustic emission amplitude. Qualitative parameters: gender; side of the tumor; angle between the tumor and the internal auditory canal (VS/IAC angle) < or = or > 30 degrees; MRI aspect (n = 69); surgical approach; ease of the surgical procedure, the use or non-use of laser dissection; and the histological Antoni's type of the tumor. RESULTS Pre- and perioperative factors that differed significantly between Groups 1 and 2 were as follows. Quantitative factors: tinnitus duration was longer and PTA and ABR results were worse in Group 1. Qualitative factors: heterogenous/cystic MRI aspect, use of retrosisgmoid and middle fossa approaches, easy surgical procedure, dissection without laser and Antoni's type A were more frequently found in Group 1.

Adult↗

PubMed2005

A comparison of two approaches to assessment of speech recognition ability in single cases.

Single-case design with the randomization test (RT) has been proposed as an alternative to the binomial distribution (BD) tables of Thornton and Raffin (1978) to assess changes in speech recognition performance in individual subjects. The present study investigated whether data analyzed using both approaches would result in similar outcomes. Sixty-two adults with normal hearing were evaluated using phoneme scoring and a restricted alternating treatments design under two signal-to-noise conditions. Results revealed a significant correlation between the RT and a BD analysis using at least 50-word lists, although the BD analysis was a more sensitive measure. The absence of correlation between the RT with a BD analysis using 25-word lists challenges the common clinical practice of using reduced list size, and supports the use of phoneme scoring and other attempts to find clinically acceptable yet evidence-based solutions to overcome the conflict between time and accuracy.

Acoustic Stimulation↗

PubMed2002

Speech reception thresholds obtained in a symmetrical four-loudspeaker arrangement from bilateral users of MED-EL cochlear implants.

OBJECTIVE: The purpose of the study was to investigate speech reception in noise in subjects who had undergone bilateral implantation with multichannel cochlear implants. METHODS: Nine adults with bilateral MED-EL implants were included in the study. The subjects were tested using both implants and the better implant only. Tests were performed in a symmetrical setup, which ideally eliminates any head shadow effect. Speech tests included sentences in quiet and at various signal-to-noise ratios. From the results, the gain in signal-to-noise ratios at the speech reception threshold was determined. RESULTS: All subjects showed a substantial gain in signal-to-noise ratios of approximately 4 dB on average. In addition, the gain in signal-to-noise ratios was essentially stable for as long as 4.4 years. CONCLUSIONS: The results indicate that bilateral cochlear implant users are able to binaurally process speech.

Acoustic Stimulation↗

PubMed1991

Longitudinal study of changes in speech perception between 70 and 81 years of age.

As part of a large gerontological study in Göteborg, Sweden, 376 randomly selected men and women born in 1901-1902 underwent pure-tone and speech audiometry at the age of 70 years in 1971-1972. The survivors of the 1901-1902 cohort were tested again at the ages of 75, 79 and 81 years. A second group consisting of 297 men and women born in 1906 was also tested with pure-tone and speech audiometry at the ages of 70 and 75 years. We found that the median speech discrimination scores for the 1901-1902 cohort decreased moderately with increasing age: between the ages of 70 and 81 years scores decrease 10% for men and 8% for women for the worse ear and 7 and 6% for the better ear in this group. The median speech reception threshold increased 15 dB over the 11-year period for both men and women, an increase in good agreement with the increase in the pure-tone threshold over this period. Those born in 1906 had a slightly lower discrimination score (4%) when tested at the age of 70 years compared to those born in 1901 tested at the same age. As many as half of the 81-year-old persons would have a theoretical benefit from hearing aid amplification.

Aged↗

PubMed1998

An adaptive noise canceller for hearing aids using two nearby microphones.

An adaptive noise cancellation scheme based on two-stage adaptive filtering as proposed by Van Compernolle [Proceedings of the IEEE International Conference on Acoustics, Speech and Signal Processing (IEEE, New York, 1990)] was tested for two identical directional microphones mounted in an endfire configuration within a single behind-the-ear (BTE) hearing aid. Speech intelligibility tests were carried out with two normal hearing subjects and three hearing aid users with moderate hearing losses, in a realistic test environment using open set words and sentences. A significant improvement, on average more than 5 dB, of speech reception threshold (SRT) in background noise was obtained.

Amplifiers, Electronic↗

PubMed2002

Adaptive noise suppression for a dual-microphone hearing aid.

An adaptive beamformer for behind-the-ear dual-microphone hearing aids has been optimized for speech intelligibility enhancement in the presence of disturbing sounds or noise. The noise reduction approach is based on the scheme presented by Vanden Berghe and Wouters (1998). A real-time implementation of the signal processing is realized in Audallion, a wearable, small digital signal processing (DSP) platform. After physical evaluation, speech-in-noise intelligibility tests have been carried out on three normally-hearing and two hearing-impaired subjects. A significant speech reception threshold improvement of 11.3 dB was obtained in a moderately reverberant environment for one jammer sound source (steady speech-weighted noise or multi-talker babble) in a direction of 90 degrees relative to the direction of the speech.

Auditory Threshold↗

PubMed1998

Bizarre "sawtooth" tympanogram in a patient with otitis media.

A patient evaluated for otitis media had a bizarre tympanogram with a "sawtooth" configuration. Acute otitis media with a pinpoint perforation was diagnosed. After resolution of the acute infection, a 2-mm diameter perforation remained and the presence of a patulous eustachian tube was documented. Tympanoplasty was eventually required, after which a normal tympanogram was recorded. Our interpretation of the tympanogram is discussed and the literature reviewed.

Acoustic Impedance Tests↗

PubMed1996

Speech intelligibility index transfer functions and speech spectra for two Swedish speech recognition tests.

Speech spectra and Speech Intelligibility Index (SII) transfer functions are presented for the Swedish PB word material (SPB) and for a Swedish sentence material known as Hagerman's Sentences (HS). The transfer function were derived from the normative recognition scores in noise previously obtained from normal-hearing subjects. The transfer function for HS is very similar to a transfer function for familiar English sentences. The function for SPB is more like functions of other monosyllabic word test materials. The slope of the HS transfer function is twice as steep as the slope of the SPB function. The long-term rms spectra of the speech materials and their associated noise signals are presented and recommended to facilitate accurate SII calculations with these speech tests.

Hearing↗

PubMed2005

Effect of slow-acting wide dynamic range compression on measures of intelligibility and ratings of speech quality in simulated-loss listeners.

The purpose of this study was twofold: (a) to determine the extent to which 4-channel, slow-acting wide dynamic range amplitude compression (WDRC) can counteract the perceptual effects of reduced auditory dynamic range and (b) to examine the relation between objective measures of speech intelligibility and categorical ratings of speech quality for sentences processed with slow-acting WDRC. Multiband expansion was used to simulate the effects of elevated thresholds and loudness recruitment in normal hearing listeners. While some previous studies have shown that WDRC can improve both speech intelligibility and quality, others have found no benefit. The current experiment shows that moderate amounts of compression can provide a small but significant improvement in speech intelligibility, relative to linear amplification, for simulated-loss listeners with small dynamic ranges (i.e., flat, moderate hearing loss). This benefit was found for speech at conversational levels, both in quiet and in a background of babble. Simulated-loss listeners with large dynamic ranges (i.e., sloping, mild-to-moderate hearing loss) did not show any improvement. Comparison of speech intelligibility scores and subjective ratings of intelligibility showed that listeners with simulated hearing loss could accurately judge the overall intelligibility of speech. However, in all listeners, ratings of pleasantness decreased as the compression ratio increased. These findings suggest that subjective measures of speech quality should be used in conjunction with either objective or subjective measures of speech intelligibility to ensure that participant-selected hearing aid parameters optimize both comfort and intelligibility.

Acoustic Stimulation↗

PubMed2007

Evaluation of the benefit for cochlear implantees of two assistive directional microphone systems in an artificial diffuse noise situation.

OBJECTIVE: People with cochlear implants have severe problems with speech understanding in noisy surroundings. This study evaluates and quantifies the effect of two assistive directional microphone systems compared to the standard headpiece microphone on speech perception in quiet surroundings and in background noise, in a laboratory setting developed to reflect a situation whereby the listener is disturbed by a noise with a mainly diffuse character due to many sources in a reverberant room. DESIGN: Thirteen postlingually deafened patients, implanted in the Leiden University Medical Centre with the Clarion CII device, participated in the study. An experimental set-up with 8 uncorrelated steady-state noise sources was used to test speech perception on monosyllabic words. Each subject was tested with a standard headpiece microphone, and the two assistive directional microphones, TX3 Handymic by Phonak and the Linkit array microphone by Etymotic Research. Testing was done in quiet at a level of 65 dB SPL and with decreasing signal-to-noise ratios (SNR) down to -15 dB. RESULTS: Using the assistive directional microphones, speech recognition in background noise improved substantially and was not affected in quiet. At an SNR of 0 dB, the average CVC scores improved from 45% for the headpiece microphone to 67% and 62% for the TX3 Handymic and the Linkit respectively. Compared to the headpiece, the Speech Reception Threshold (SRT) improved by 8.2 dB SNR and 5.9 dB SNR for the TX3 Handymic and the Linkit respectively. The gain in SRT for TX3 Handymic and Linkit was neither correlated to the SRT score with headpiece nor the duration of CI-use. CONCLUSION: The speech recognition test in background noise showed a clear benefit from the assistive directional microphones for cochlear implantees compared to the standard microphone. In a noisy environment, the significant benefit from these assistive device microphones may allow understanding of speech with greater ease.

Adult↗

PubMed2005

Speech and language development in cognitively delayed children with cochlear implants.

OBJECTIVE: The primary goals of this investigation were to examine the speech and language development of deaf children with cochlear implants and mild cognitive delay and to compare their gains with those of children with cochlear implants who do not have this additional impairment. DESIGN: We retrospectively examined the speech and language development of 69 children with pre-lingual deafness. The experimental group consisted of 19 children with cognitive delays and no other disabilities (mean age at implantation = 38 months). The control group consisted of 50 children who did not have cognitive delays or any other identified disability. The control group was stratified by primary communication mode: half used total communication (mean age at implantation = 32 months) and the other half used oral communication (mean age at implantation = 26 months). Children were tested on a variety of standard speech and language measures and one test of auditory skill development at 6-month intervals. RESULTS: The results from each test were collapsed from blocks of two consecutive 6-month intervals to calculate group mean scores before implantation and at 1-year intervals after implantation. The children with cognitive delays and those without such delays demonstrated significant improvement in their speech and language skills over time on every test administered. Children with cognitive delays had significantly lower scores than typically developing children on two of the three measures of receptive and expressive language and had significantly slower rates of auditory-only sentence recognition development. Finally, there were no significant group differences in auditory skill development based on parental reports or in auditory-only or multimodal word recognition. CONCLUSIONS: The results suggest that deaf children with mild cognitive impairments benefit from cochlear implantation. Specifically, improvements are evident in their ability to perceive speech and in their reception and use of language. However, it may be reduced relative to their typically developing peers with cochlear implants, particularly in domains that require higher level skills, such as sentence recognition and receptive and expressive language. These findings suggest that children with mild cognitive deficits be considered for cochlear implantation with less trepidation than has been the case in the past. Although their speech and language gains may be tempered by their cognitive abilities, these limitations do not appear to preclude benefit from cochlear implant stimulation, as assessed by traditional measures of speech and language development.

Child, Preschool↗